Harm Reduction for Stimulants

Discussion in 'Pharmacology' started by Nicaine, Nov 3, 2006.

  1. Nicaine

    Nicaine Titanium Member

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    Jul 12, 2004
    from Rhode Island, U.S.A.
    Part 1 - Prescription Medications for Stimulant Harm Reduction

    Since these prescription drugs are quite potent, often they will not be used unless there's a need. However, some of them can safely be taken in lower doses as a protective measure. Some of them can and will interfere with the stimulant "high" in various ways.

    Everything discussed herein is based on SWIM's personal experience and research, and should never substitute for medical advice. I cannot advise where/how to acquire any of the medications listed here, but he recommends consulting directly with your physician and being honest about your drug use and desire to acquire medication(s) for the purpose of harm reduction.

    Unless advised directly by a physician, SWIM suggests a starting "harm reduction dosage" of exactly 50% (half) of the lowest doctor-prescribed dose for any given medication. Such a dosage will tend to have some positive effects, while minimizing potential negatives. This is especially important before you know how a drug will affect you.

    Beta Blockers -- example of generic drug names are propranolol and atenolol. This class of medication blocks adrenaline from affecting certain types of receptors in the body (beta-adrenergic), but not other types. Its most obvious effect is to slow the heartbeat down, and it also lowers blood pressure when used under normal conditions.

    This may sound really useful in conjunction with stimulants, but there's a risk involved. Because it only blocks a certain type of adrenaline receptor, the effects of stimulants on the other type (alpha-adrenergic) can be increased. This often results in vasoconstriction (constricted blood vessels) and paradoxically *increased* blood pressure. For this reason, beta blockers should normally be used only with extreme caution while high on cocaine or amphetamines. Blood pressure should be monitored! They may be used in combination with a vasodilating drug such as enalapril maleate, but it usually isn't advised. Rapid heart rate is usually not dangerous, therefore you should generally avoid beta blockers while on coke or speed.

    One exception is a beta blocker called labetalol, which has both alpha- and beta-adrenergic blocking properties. This drug has been used in emergency cardiac conditions involving cocaine and/or amphetamines. It will definitely "kill the high" a lot, and should not be used unless there's a heart problem occurring.

    Verapamil - also known as COVERA-HS, CALAN, ISOPTIN, and VERELAN. Verapamil is a "calcium channel blocker" that dilates both cardiac and peripheral blood vessels, resulting in a drop in blood pressure. It can also result in warming/flushing of the skin. Verapamil is used to treat high blood pressure, angina (heart pain) and certain arrythmias. Thus, it's a very useful medication for stimulant harm reduction, and one of the safer ones as well. The side effect profile is excellent compared to most other cardiac drugs.

    Here are some links to further info:




    I recommend stimulant users acquire and have some verapamil on standby, for use if (A) blood pressure gets too high, (B) the heart starts beating irregularly, or (C) chest pain is encountered.

    Benzodiazepines - Valium, Ativan, Klonopin, Xanax and other drugs in this family. These are sedatives that can help "bring down" a person if they get agitated or anxious or "too high" on stimulants.

    Every stimulant user should probably have these around in case of emergency. Xanax (alprazolam) is probably the fastest-acting, thus best for emergencies. However, it can also be one of the most addictive of the benzos. Ativan (lorazepam) is another excellent choice, as is Klonopin (clonazepam). The latter has a long half life and tends to be one of the least addictive.

    Caution should be used with benzodiazepines, as they are highly addictive. However, there's really no substitute. Due to brain biochemistry, the benzo will always "win" if given along with a stimulant, helping to bring the user down.

    Flonase, Beconase AQ - These drugs come in the form of nasal sprays and are primarily for cocaine users who insufflate (snort) their drug of choice. This may of course also be applicable to amphetamines and such. Steroidal nasal sprays decrease nasal congestion over time, and are a much better choice than 12-hour or 24-hour over-the-counter nasal sprays, which can cause severe problems in combination with cocaine use (including profuse bleeding, severe rebound congestion and accelerated tissue death in the nose). Regular cocaine users should strongly consider getting one of these drugs prescribed.

    Part 2 - Food and Fluid Intake

    Proper stimulant harm reduction involves (A) constant/steady intake of fluids, but not insane or outrageous levels of intake. Water or diet soft drinks are preferred over sugary soft drinks which may rot the teeth. (B) Easy-to-take high protein/carbohydrate foods such as chocolate milk, yoghurt, plain deli luncheon meats, protein bars and meal replacement shakes. Bananas can be eaten pretty easily. Simple carbs are fine for quick energy (i.e. corn syrup, sugars), as complex carbs/fibers will be difficult to choke down for most people who are high on stimulants. Remember that energy has to come from somewhere. If it isn't being generously supplied during stimulant use, it's being depleted from muscle tissue and fat stores. If one's body fat index is low, they are literally wasting away as the body digests muscle tissue for energy.

    Emergency Electrolyte Balancing -- note that Gatorade does NOT contain the right balance of fluids/electrolytes to resupply your body if you're dehydrated from sweating or have been drinking large amounts of water or other "plain" fluids all night. If you don't have any electrolyte tablets available (you should get some!), consume the following: (1) 1/4 banana for Potassium, (2) ~50mg Magnesium (possibly from multivitamin), (3) 1/8 teaspoon salt for sodium and chloride, and (4) Yogurt or milk for calcium. If possible, add sources for vitamin C and Zinc. This combination will at least keep you from keeling over or dying if you've been sweating out electrolytes all night, and may help prevent painful muscle cramps.

    (To Be Continued...)
    Last edited: Nov 4, 2006
  2. toe

    toe Gold Member

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    Jun 16, 2007
    from earth
    Reduced-sodium V-8. (That's mixed vegetable juice, for the international crew).

    Apologies. Will return to complete sentences as soon as capable.
  3. Laudaphun

    Laudaphun Gold Member

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    Jan 14, 2007
    from U.S.A.
    First off, this is a great thread and I think it should be stickied. After all, safety is our #1 concern right? Well, some of us anyways. A question I have regarding the original post is that it was stated that
    , however would it be fair to say that temazepam would be a bit more effective? While temazepam is not nearly as abundant for most as alprazolam would likely be, if I am in a situation where she has an intense panic reaction whether it be to a drug, or more likely just a life situation, she goes for the temazepam everytime. Alprazolam would be her #2 choice, but for this simple reason, and even though they are technically prescribed as sleeping pills, SWIM keeps some temazepam with her at all times. SWIM's emergency kit that goes with her everywhere consists of methylphenidate, clonazepam, alprazolam, temazepam. Sorry, not trying to argue, just giving SWIM's opinion.

    Anyways, how do people feel about the safety of benzos (at therapeutic doses) along with a stimulant like methylphenidate on a regular basis or semi-regular basis. For some reason SWIM always tried to wait until methylphenidate had worn off before consuming any benzo except in emergency situations. But for example, SWIM works in a laboratory sometimes which is fairly crowded. This creates panic in SWIM, eventually one day SWIM broke down and consumed a 1mg clonazepam tablet before going into the laboratory, while being under the influence of methylphenidate at the same time. Now before you say anything about safety and taking a benzo before going into a lab, I am very tolerant of benzos and 1mg clonazepam is a small dose for SWIM. It does not make him a saftey risk.

    SWIM can't find anything in pharmacology texts stating that there is any kind of interaction, but is this healthy? I do not take alprazolam or temazepam while under the effects of methylphenidate unless emergency, which has not happened yet. Methylphenidate dosages are 10mg as needed (typically per 4-5 hours). Is it safe to consume benzos at the same time as stimulants like methylphenidate? Obviously it would have to be a small enough dose so that it wouldn't cancel out the methylphenidate, but large enough that it deals with the anxiety/panic. SWIM sticks with clonazepam as it seems the mildest of the benzos SWIM regularly consumes and 1mg clonazepam seems to have a positive effect along side of 10mg methylphenidate when necessary. But is this a health risk? Opposing forces.

    Keep in mind that SWIM's use of stimulants are strictly at prescribed doses and for therapeutical reasons. As a matter of fact, I do not particularly like stimulants in a recreational context... However I do find stimulants such as methylphenidate very useful in treating whatever it is that is wrong with SWIM, ADD or whatnot. I have never felt real comfortable about the use of stimulants, but is becoming more and more convinced that when used properly, under the care of a dr. they are safer and more useful than she'd previously given them credit for. I do not use benzos to "come down" from stimulant use as there is no "come down" to come down from... Her focus just simpily begins to drift.
    Last edited: Mar 22, 2008
  4. jazzmetalguitar

    jazzmetalguitar Titanium Member

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    Oct 16, 2007
    from U.S.A.
    A great start, other than the fact that I would never call use of benzos for a come-down "harm reduction" unless amphetamine psychosis has set it. Otherwise, I feel it could potentiate the already inevitable rebound of the dopaminergic system. For example, without benzos, SWIM's body once rebounded much too hard and sent him into a hypoxic attack (lack of oxygen in the blood; explained likely by counteractive breathing retardation and vasoconstriction while the body's system was attempting to reset to normal).
  5. Tweak92

    Tweak92 Newbie

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    Dec 3, 2008
    Nice guide but you forgot to mention antipsychotics which would help a lot if the person is going through stimulant-induced psychosis, promethazine is probably the easiest to obtain...
  6. Herbal Healer 019

    Herbal Healer 019 Silver Member

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    Sep 24, 2008
    from france
    I can't stress low dosage use enough, especially with strong stimulants like adderall. IMO no1 should exceed 50mg even with a tolerance, bcuz dosages above 20-30mg are probably terrible 4 the cardiovascular system.

    So stick to low doses out there if SWIy does'nt want to set themselves up for an inebidable heart attack in the future.

    The best way to do a low dose & still get good effects is to either plug (shuv it where the sun don't shine) or insufflate.

    ***Also remember, when I say 20-30mg, I mean 20-30mg was actually absorbed into the blood. So for instance, the oral bioavailability of adderall is 25% meaning 30mg is only giving the effect of 7.5mg adderall, which makes it quite apparent that oral administration is a waste of adderall, whereas that same 30mg adderall taken rectally would be anywhere from 28.5mg-29.7mg or intranasally would be 22.5mg.***
    Last edited: Dec 10, 2008
  7. Laudaphun

    Laudaphun Gold Member

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    Jan 14, 2007
    from U.S.A.
    SWIM being rather ignorent of stimulants when first prescribed to her, had no idea of their comparative strengths. After some experimental dosages with an average day being around 30mg methylphenidate... For some reason switched back to adderall (which were left over from a previous trial at which 15mg twice daily was prescribed.) SWIM figured she'd give the adderall (racemic amphetamine salts) another try, but at 22.5mg twice daily... seemed to work wonders at first, much better than the 10mg methylphenidate x3 daily and not really any stronger other than duration (upon a first look.) At the next shrink visit, SWIM mentioned this and while the dr. did not seem alarmed at SWIM increasing dosage to 45mg per day despite the fact that he follows strict text book and will not treat ADHD/ADD with anything higher than 40mg adderall per day (which I felt was perfect.) After all, the reason for SWIM taking 22.5mg twice daily was a result of having 30mg tablets taht split into quarters. After 20mg twice daily for a week or two SWIM began realizing just how much stronger this medication was, and cut back to 15mg afternoon doses and sometimes in the morning. Eventually found that 10-15mg upon waking and then redose of 10mg 5-7 hours later was still plenty strong. It was not real obviously noticeable like the methylphenidate... These meds are tough for SWIM to figure out and has learned that the lower the better, and once you find someting hat works... you should pinch yourself everytime the thought, "this works pretty good, therefore a more potent medication should work even better!" Well, maybe, if you get the dose just right, but... the meds can work very differently for different people and this is not always easy to do.

    This can be a very costly way to think and then you end up back where you started, trying to figure out what works best.

    The dumbest thing SWIM then did was ask to then switch back to methylphenidate (now at 60mg per day as opposed to the original 30-40mg)... Pharmacopia recommends "drug holidays" with all ADHD/ADD meds. Probably not a bad idea to keep from tolerance.

    And all else aside, SWIM's quality of work is far superior on the absolute least amount of methylphenidate/amphetamine that is effective. It is very easy to be deceived into thinking these drugs are improving performance or make performance capabilities greater, however this is often where the major problem lies and many don't realize it for a while. <Going to edit after quote is found> 3 main reasons for the failure of stimulants when they should not.

    Also, I have noticed, that perhaps something limited just to her marmoset but if you use nicotine, or are a former user of nicotine... treadly lightly. Addictive potential for one can affect the other. If you already use nicotine and are not planning on quitting, perhaps not such a big deal, but if you relapse on nicotine or start smoking after put on ADD meds, or try to quit nicotine while on ADD meds one seems to want to compensate for the other and this can be problematic. Not even something you may notice. Pretty sure there is a good pharmacological explanation for this but it is now bedtime.
    Last edited: Dec 12, 2008
  8. snubi

    snubi Newbie

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    May 29, 2010
    from denmark
    I have been to the ER a couple of time with a stimulant od times. And each time the first thing they gave me was 15mg Diazepam IV
  9. nanodesu

    nanodesu Newbie

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    Sep 28, 2011
    from hungary
    According to SWIM you shouldn't take zolpidem with stimulants. Since zolpidem can have stimulant-like effects, the sedative part will weaken and very strange hallucinations can appear, but the main danger is fear and shame inhibition. It can feel like you can do anything perfectly without any consequences. The amnesic effect can weaken, but it's still there.
    Cannabis(and other CB1 agonists) have a synergistic effect with stimulants, you should be cautious when combining the two. You should especially cautious with caffeine, since it's available in high doses , combined with cannabis it can give you a very hard "drag" feeling with high pulse rate and high blood pressure.

    nanodesu added 17 Minutes and 9 Seconds later...

    EDIT: The zolpidem thing only happened to SWIM and two highly-trained monkeys, so it's not a good set of data. If someone could provide confirming or refuting data, that would be great!
    Note that since I'm a newbie I can't edit my posts, that's why I made a second one. A moderator should put the part above in my previous post.
    Last edited: Oct 1, 2011